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26th February 2025
A 73-year-old gentleman is seen on the medical take with shortness of breath.
A 73-year-old gentleman is seen on the medical take with shortness of breath. Whilst assessing him, you note a small amount of haemoptysis, and he tells you he has coughed up some blood in the last few days. He has been feeling generally run down recently, although he put this down to old age and has lost some weight. He has no past medical history and lives alone.
On examination you notice a purpuric rash over the lower limbs. Additionally, he has a foot drop and weakness of finger extension on the right side.
He has blood tests performed, which show:
| Admission | 12 m previously | Normal range | |
|---|---|---|---|
| Hb | 132 | 134 | (135-170) |
| WCC | 10.2 | 8.3 | (3.5-11.0) |
| Plt | 450 | 350 | (140-400) |
| Neut | 7.4 | 6.4 | (1.7-7.5) |
| Eosinophils | 0.15 | 0.13 | (0.0-0.5) |
| Basophils | 0.07 | 0.08 | (0.0-0.1) |
| ESR | 95 | 15 | |
| Urea | 6.5 | 5.4 | (2.9-8.2) |
| Creatinine | 125 | 85 | (66-112) |
| eGFR | 45 | >90 | |
| CRP | 84 | 5 | (0-5) |
| ANCA | Positive | ||
| PR3 Ab | <1 | (0-3) | |
| MPO Ab | 38 | (0-5) |
What is the most likely diagnosis?
Select the SINGLE most appropriate option from the list below. Select ONE option only.
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